Management of abdominal wound dehiscence: update of the literature and meta-analysis
Management of abdominal wound dehiscence: update of the literature and meta-analysis
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DOI：
10.1007/s10029-020-02294-4
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发表时间：
2020-09-08
期刊：
影响因子：
2.3
通讯作者：
van Ramshorst, Gabrielle H.
中科院分区：
文献类型：
--
作者：
Denys, Andreas;Monbailliu, Thomas;van Ramshorst, Gabrielle H.
目的腹部伤口裂开(AWD)是一种发病率和死亡率较高的疾病。我们的目标是提供AWD管理战略的当代概述。方法计算机检索PubMed、EMBASE、Cochrane图书馆和临床试验注册中心，检索词分别为“腹部伤口裂开”、“筋膜裂开”和“腹部破裂”，检索词为“腹部伤口裂开”、“筋膜裂开”和“腹部破裂”。研究结果包括手术部位感染(SSI)、复发、切口疝和30天死亡率。EHS临床指南报道的关于AWD的研究被包括在内，并与之进行了比较。采用OpenMetaAnalyst软件进行Meta分析，计算统计学意义和优势比(OR)。结果19项研究共涉及632名患者，其中16项为回顾性研究，1项为早期终止的随机对照试验，1项为综述，并符合欧洲疝气协会的指南。9项研究报告使用了合成网片(n=241)，其中2项使用了真空辅助网片介导的筋膜牵引(VAWCM)(n=19)，6项不使用VAWCM(n=198)，1项使用了同时使用VAWCM(n=6)和不使用VAWCM(n=18)；2项使用了生物网片(n=19)。7项研究报告了一期缝合(n=299)。有三项研究报告了另一种方法(n=91)。术后随访1~96个月。Meta分析比较一期缝合组和合成网片组。根据结果不同，异质性为低到中等。一期缝合组的SSI发生率为27.6%，人工网片组为27.9%，其中5例患者植入网片；OR为0.65(95%CI为0.23~1.81)。人工网组和一期缝合组的腹壁切口率分别为11.1%(19/171)和30.7%(67/218)，OR为4.01(95%CI为1.70~9.46)。复发率人工网组为2.7%(3/112)，一期缝合组为10.2%(21/206)，OR为1.81(95%CI为0.18~17.80)，差异无统计学意义。与人工网片相比，一期缝合组的死亡率为11.2%-16.7%；OR为1.85(95%可信区间为0.91-3.76)。结论纳入的研究质量低到很低。使用合成网片可显著降低切口疝气的发生率，而SSI的发生率与一期缝合修补相当。
Purpose Abdominal wound dehiscence (AWD) is associated with significant morbidity and mortality. We aimed to provide a contemporary overview of management strategies for AWD. Methods PubMed, EMBASE, the Cochrane library and a clinical trials registry were searched from 2009 onwards using the key words "abdominal wound dehiscence", "fascial dehiscence" and "burst abdomen". Study outcomes included surgical site infection (SSI), recurrence, incisional hernia and 30-day mortality. Studies reported by the EHS clinical guidelines on AWD were included and compared with. OpenMetaAnalyst was used for meta-analysis to calculate statistical significance and odds ratios (OR). Results Nineteen studies were included reporting on a total of 632 patients: 16 retrospective studies, one early terminated randomized controlled trial, one review and the European Hernia Society guidelines. Nine studies reported use of synthetic mesh (n = 241), two of which used vacuum-assisted mesh-mediated fascial traction (VAWCM) (n = 19), six without VAWCM (n = 198) and one used synthetic mesh with both VAWCM (n = 6) and without VAWCM (n = 18); two used biological mesh (n = 19). Seven studies reported primary suture closure (n = 299). Three studies reported on an alternative method (n = 91). Follow-up ranged between 1 and 96 months. Meta-analysis was performed to compare the primary suture group with the synthetic mesh group. Heterogeneity was low to moderate depending on outcome. The overall SSI rate in the primary suture group was 27.6% versus 27.9% in the synthetic mesh group, resulting in mesh explantation in five patients; OR 0.65 (95% CI 0.23-1.81). Incisional hernia rates were 11.1% in the synthetic mesh group (19/171) and 30.7% in the primary suture group (67/218); OR 4.01 (95% CI 1.70-9.46). Recurrence rate did not show a statistically significant difference at 2.7% in the synthetic mesh group (3/112), compared to 10.2% in the primary suture group (21/206); OR 1.81 (95% CI 0.18-17.80). Mortality rates varied between 11.2% and 16.7% for primary suture group versus synthetic mesh; OR 1.85 (95% CI 0.91-3.76). Conclusion Included studies were of low to very low quality. The use of synthetic mesh results in a significantly lower rate of incisional hernia, whereas SSI rate was comparable to primary suture repair.